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Private Onsite Wastewater Treatment County <br /> >� s` Systems ( POWTS) Inspection Report Burnett <br /> (Attach to Permit) Sanitary Permit No: <br /> Industry services Division SAN-23-252 <br /> General Information <br /> Personal information you provide may be used for secondary u ses Privacy Law,s. 15.04 1 m <br /> Permit Holder's Name: U City U Village Id Town of: State Plan Transaction ID#: <br /> Tindell Lake Cabin LLC Scott 656841 <br /> CST BM Elev: jlnsp BM Elev: BM Description: Parcel Tax No: <br /> Top of riser 18810 <br /> Tank Information setback to: <br /> TYPE MANUFACTURER CAPACITY Prop. Line Well Building Air Intake Road <br /> Septic N/A <br /> Dosing N/A <br /> Aeration N/A <br /> Holding Wieser 2000 +2' +25' +5' <br /> Pump/Siphon Information Elevation Data <br /> Pump Manufacturer Pump Model Demand STATION BS HI FS ELEV <br /> Filter Manufacturer Filter Model GPM Benchmark 1.24 101.24 100 <br /> TD I Lift Friction Loss Head Total Bldg.Sewer 3.86 97.38 <br /> Forcemain Length Dia Dist.To Well Tank Inlet 5.2 96.04 <br /> Tank Outlet <br /> Dispersal Cell Information Dose Tank Inlet <br /> DIMENSIONS Width Length #of Cells Dose Tank Bottom <br /> SETBACK FROM Prop.Line Building Well OHWM Inst.Contour <br /> Type of Cell Manufacturer: Header/Manifold <br /> Distribution Pipe <br /> None Model Number: Infiltrative Surface <br /> Pretreatment Unit Final Grade <br /> Manufacturer: <br /> Model Number: <br /> Distribution System X Pressure Systems Only <br /> Header/Manifold Distribution Pipe(s) X Hole Size X Hole Observation Pipes <br /> Length Dia Length Dia Spac Spacing ❑Yes ❑No <br /> Soil Cover <br /> Depth Over Depth Over Depth of Seeded Sodded Mulched <br /> Cell Center Cell Edges To soil ❑Yes ❑No ❑Yes ❑No <br /> COMMENTS:(Include code discrepancies,persons present,etc.) <br /> - 4 4,- <br /> Plan revision required? ❑Yes 17 No 11 29 2023 1565671 <br /> Use other side for additional information. <br /> Date POWTS Inspector's Signature License Number <br /> SBD-6710(R.03/21) <br />